Does B65.0 require prior authorization?

No, B65.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`B65.0`, Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis]

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.

Key Coverage Criteria

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Optical Biopsy System (SpectraScience): "an adjunct to lower gastrointestinal endoscopy for the evaluation of polyps less than 1 cm in diameter that the physician has not already elected to remove. The device is only to be used in deciding whether such polyps should be removed (which includes submission for histological examination)." (FDA PMA statement in text).
Narrow Band Imaging (NBI): differentiation of colorectal polyps (neoplastic vs non-neoplastic) and enhancement of adenoma detection during colonoscopy (multiple RCTs and systematic reviews evaluated NBI for adenoma detection and polyp characterization).
High-definition chromoendoscopy / dye chromoendoscopy: detection of flat and depressed neoplasms and increased polyp/adenoma detection compared with conventional colonoscopy (evaluated particularly for colorectal cancer screening and IBD surveillance).
Confocal Laser Endomicroscopy (CLE) / probe-based CLE (pCLE) / needle-based CLE (nCLE): in-vivo, real-time microscopic imaging to (as evaluated in the literature) aid in diagnosis and characterization of GI mucosal lesions, including - discrimination of colorectal neoplasms from non-neoplasms, - surveillance and detection of dysplasia in Barrett’s esophagus (including confirmation of low-grade dysplasia), - assessment of completeness of endoscopic mucosal resection (EMR) and detection of r [...]

4 Active Policies

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

AETNA-CPB-0783, In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

`B65.0`, Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis]

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

B65.0, Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis]

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`B65.0`, Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis]